Mammography is the most important imaging procedure for breast cancer detection and diagnosis. It can be performed in a screening setting or a diagnostic setting.
Screening is performed periodically in order to find small cancers before they are detected through self-palpation or clinical breast examination. It is performed every 1, 2, or 3 years (depending on age, the regional screening programme, or the advice of one’s doctor), from the age of 40–50 years until around 70–75. Relevant differences in screening programmes across European countries, including ways of reporting, are due to differences in culture, technical circumstances, biopsy options, financial restrictions and breast cancer prevalence. Women with a high frequency of breast cancer in their family should start even earlier with periodic imaging, possibly using magnetic resonance imaging , after consulting specialised centres, since mammograms in this age group have very limited value due to the higher density of breasts. Screening mammography is a standardised procedure composed of four views, two for each breast. It can be performed by a radiographer alone, and the resulting images are usually read by two radiologists, independently, in separate sessions. If the exam is judged negative (no suspicious findings), the woman receives a letter communicating this result. If something suspicious is found, the woman is recalled for a tailored further assessment (additional mammographic views, ultrasound and/or needle biopsy).
This is performed in patients presenting with clinical symptoms such as a palpable lump, nipple discharge, or skin or nipple retraction, in order to diagnose or exclude breast cancer. It should be performed by a radiographer under the supervision of a radiologist. Before acquiring the four standard projections, a full clinical breast examination is performed, usually by the same radiologist, or the radiologist must have the results of a full clinical breast examination recently performed by another doctor. All palpable abnormalities and scars from previous surgeries are highlighted by attachment of a marker to the skin. If necessary, additional views are acquired after the standard procedure. A formal written report is prepared by the radiologist with conclusions, including recommended further steps.
If you have a planned screening mammography and you notice relevant symptoms, go to your radiologist in order to decide if you need a diagnostic mammography. However, if you have symptoms and you are getting a screening mammography, inform the radiographer about them! The radiologists reading your images will decide whether you should be recalled based on these symptoms. In any case, if your symptoms do not disappear, you should consult your radiologist even if your mammography has been judged negative.